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General NPI Number Information
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NPI Number | 1154331544
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA PODIATRY INC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 4340 LADSON RD SUITE C
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City | LADSON
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State | SC
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Zip | 29456-6444
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Country | US
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Telephone | 843-851-9069
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Fax |
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Provider Business Mailing Address
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Address Line | 4340 LADSON RD SUITE C
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City | LADSON
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State | SC
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Zip | 29456-6444
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Country | US
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Telephone | 843-851-9069
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM HAL HATCHETT
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Credential | DPM
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Telephone | 843-851-9069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 556
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License Number State | SC
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